Attachment F
Action List
Interim Assistance Reimbursement (IAR)
Certificate of Authority
(Attachment A)
o Identify who will need a SSA PIN and Password. These individuals must be listed on the form by Name and Job Title. If additional spaces are needed, either add them to the word file itself or copy the second page as needed.
o Complete Agency Contact Information.
o Identify who will receive “alert” e-mails. The SSA automated system can only support three e-mail addresses per agency, so OFT is creating a ListServe for each SSD, and the e-mail address follows the template: OTDA.dl.eIAR.(district name). This address should be listed as one of the three available e-mail addresses. It is essential that e-mail addresses listed are maintained and accessed.
o Place the Certificate of Authority form on an Agency Letterhead.
o Sign form – The Certificate of Authority must be signed by an official of the Agency. An official is an individual who represents and speaks for the Agency. An official is an Agency Director, Assistant Director, or other individuals who speak for the Agency or who are authorized to sign for the Director.
o Mail the completed and signed form along with the Direct Deposit Information to:
Justin Gross
New York State
Office of Temporary and Disability Assistance
40 North Pearl Street, 14th floor section C
Albany, New York 12243-0001
Note: It is essential that SSDs be diligent in maintaining the e-mail mailboxes identified in the Certificate of Authority because if the mail boxes are not accessed a SSD will not be alerted to the need to complete the required IA data, and they will not recover their share of the Interim Assistance Reimbursement payment.
Direct Deposit Information
(Attachment B)
o Identify if a new account needs to be established for the direct depositing of the SSD’s share of the IAR payment, and do so if necessary.
o Contact the bank if help is needed to fill out the banking information section of the form.
o Inform the bank of the future direct depositing agreement and obtain the bank contact information.
o Place the Direct Deposit Information form on an Agency Letterhead.
o Sign form – The Direct Deposit Information form should be signed by an individual in charge of the SSD’s bank account information.
o Mail the completed and signed form along with the Certificate of Authority to:
Justin Gross
New York State
Office of Temporary and Disability Assistance
40 North Pearl Street, 14th floor section C
Albany, New York 12243-0001
GSO e-IAR Website Registration Form
(Attachment C)
o Identify who in your agency will need access to the SSA secure website.
o Complete User contact Information Section of Form for each individual requiring access to the SSA secure website.
o The SSA will complete the sponsor Verification section.
o Confirm that anyone who is listed on a GSO e-IAR Website Registration Form is also listed by name and Job title of the Certificate of Authority. SSA will compare the GSO e-IAR Website Registration Form to the Certificate of Authority. If an individual is not listed on the Certificate of Authority, neither a PIN nor Password will be provided.
o Send completed form to the e-mail address: .
ListServe
(Attachment D)
o Identify the individual in your agency who will be responsible for maintaining the list. This individual must be on NYSeMail, OTDA’s global address list in outlook (usually a local system administrator.).
o Identifiy the members of the distribution list including the individuals that have an external e-mail address (not in Outlook.)
o Complete the information for the above mentioned individuals including name,
e-mail address, HSEN user ID (if in Outlook), and telephone number (if in Outlook.)
o Send the completed form along with the E-Reporting Form to the e-mail address: .
E-Reporting Form
(Attachment E)
o Identify the individual in your agency who will have the responsibility to monthly submit data to CEES via Centraport.
o Complete the information for the above mentioned individual including name, telephone number, e-mail address, and FAX number
o Send the completed form along with the Listserve to the e-mail address: .
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